Inspection on 10/10/06 for Ulysses House

This inspection was carried out on 10th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 27 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ulysses House 25/04/08

Ulysses House 15/10/07

Ulysses House 19/04/07

Ulysses House 04/05/06

Ulysses House 12/10/05

Ulysses House 27/04/05

Ulysses House 13/01/05

Ulysses House 01/09/04

Ulysses House 07/02/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Ulysses House 28 Fountain Road Edgbaston Birmingham West Midlands B17 8NR Lead Inspector Sarah Bennett Key Unannounced Inspection 10th October 2006 09:15 Ulysses House DS0000016734.V311792.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ulysses House DS0000016734.V311792.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ulysses House DS0000016734.V311792.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ulysses House Address 28 Fountain Road Edgbaston Birmingham West Midlands B17 8NR 0121 429 9555 0121 429 9777 ulysses653@aol.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Ulysses Care Limited Mr Richard Clark (not yet registered) Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Ulysses House DS0000016734.V311792.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents must be aged under 65 years. Date of last inspection 4th May 2006 Brief Description of the Service: Ulysses House offers accommodation for up to six young adults with learning disabilities who present with challenging behaviour. Ulysses House is a large, three storey, semi-detached Victorian house. The home is located in a residential area in Edgbaston and is well served by public transport. It is within walking distance of local shops, pubs and restaurants and the centre of Bearwood and is a short bus ride from the centre of Birmingham. Each resident has their own bedroom that has been tastefully decorated, two of which have en suite facilities. The home has a large dining room and kitchen, comfortable sitting room and utility room/laundry. The staff sleeping in room is also used as the office. The home offers a bathroom on the first floor and a WC on the ground and first floor. The premises can accommodate fully mobile adults, and does not offer disabled access or adaptations. There is a large enclosed garden to the rear of the house offering a large patio area and a lawned area. The CSCI inspection report is available in the home for visitors to read if they wish to. The Acting Manager said that the fees charged are from £1,000 – £1500 per week. Ulysses House DS0000016734.V311792.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home, a pre-inspection questionnaire and surveys completed by the residents. Following the fieldwork visit the inspector communicated by email with the consultant employed by the owner. One inspector carried out the unannounced fieldwork visit over eight and a half hours. This was the homes second key inspection for the inspection year 2006 to 2007. The staff on duty and the Acting Manager were spoken to. The inspector met with all the residents and time was spent observing care practices, interactions and support from staff. A tour of the premises took place. Care, staff and health and safety records were looked at. What the service does well: What has improved since the last inspection? The home’s statement of purpose had been updated so that prospective residents had the information they need to make a choice about whether or not they want to live there. Some parts of the home have been repainted making it a nicer and cleaner place to live. The fence in the back garden has been repaired so the garden is private for residents to spend time in. Ulysses House DS0000016734.V311792.R01.S.doc Version 5.2 Page 6 A Manager has been recruited to work at the home so that staff can be led and supported and residents will benefit from a well run home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ulysses House DS0000016734.V311792.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ulysses House DS0000016734.V311792.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents do not have all the up to date information about the home to be able to make an informed choice about whether or not they want to live there. Prospective residents individual needs are assessed to ensure that they can be met at the home. Prospective residents have an opportunity to visit the home before they move in to see if they would like to live there. EVIDENCE: The statement of purpose of the home had been updated. It included all the relevant and required information so that prospective residents can make a choice about whether or not they want to live at the home. The service users guide to the home was dated 2003 and therefore needs updating to reflect the changes in staffing and management. The Acting Manager said it had been updated recently but it could not be located. The Acting Manager said that they plan to produce the service users guide in an accessible format in the future. A new resident has moved into the home since the last inspection. An assessment of their needs was completed before they moved in. This is to ensure that the home is able to meet their needs and support them to achieve their goals. Ulysses House DS0000016734.V311792.R01.S.doc Version 5.2 Page 9 The Acting Manager said that the resident’s social worker had visited the home three times before they moved in. The resident said that they had visited the home twice before moving in to meet with the other residents and the staff. Ulysses House DS0000016734.V311792.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff do not have all the information they need to ensure that they know how to support residents to meet all their needs and achieve their goals. The choices and decisions that residents make are not always listened to, as there is not enough staff that know them well enough to support them. Residents are generally supported to take risks within a risk assessment framework. EVIDENCE: Two residents records were sampled. These included an individual care plan that stated how staff are to support the individual to meet their needs. One of the residents had been involved in a car accident where they sustained a broken leg. Their care plan had been updated since the accident so that staff knew how to support them. Some work had begun on developing care plans in a person centred way. This included the important people in the individual’s life, their life now and their life story, their health and how they can keep safe, the good things about the individual, the things they like and dislike, what their best weekday, evening and weekend is, the things that are important to Ulysses House DS0000016734.V311792.R01.S.doc Version 5.2 Page 11 them, their hopes and dreams and the goals that they would like to achieve. Only half of the person centred plan had been completed. The Acting Manager said that it had not been completed as the resident had been in hospital. Throughout the day residents were observed making choices about what they wanted to do, where they wanted to go and what they wanted to eat and drink. Sometimes these choices were limited due to staffing particularly in regard to where residents went and how much time they spent in activities out of the house. Minutes of residents meetings showed that these are held monthly. Residents discuss activities, holidays, menus and their bedrooms. One resident said that they were happy with their bedroom. Another said that they are ok with the running of the house. All residents said that they are happy with the menus. In three meetings this year one resident had requested to go on holiday to Somerset and another resident had said at three meetings that they would like to go on holiday to Wales. Staff said that a holiday had not yet been booked but they may be going at the end of the month. Residents had looked at a holiday brochure and it was likely that they would be going to Hampshire. It is not recorded how this decision was reached. The Acting Manager said that the holiday is dependent on enough staff to support the residents. Three of the residents said that they always make decisions about what they do each day and three residents said they sometimes do. In one residents records there were details of a meeting they had with their key workers. In this meeting they talked about the activities they are doing and what they would like to do, their personal care needs and their belongings and what they would like to buy. It was not clear whether their wishes were followed. Resident’s records sampled included individual risk assessments. These detailed how staff are to support the individual to minimise the risks involved in using the stairs, their behaviour and the behaviour of others, going out in the community, eating and drinking, going out on their own without staff support and neglecting their personal care. The risk assessments had been reviewed recently and updated to reflect any changes. Some staff had signed to say they had read the risk assessments. It is recommended that all staff read these and sign to say they have done so, so that all staff are supporting the individual appropriately. Resident’s records included records of how often residents slept during the night. These indicated that staff are checking residents every half an hour during the night. The Acting Manager said that staff are not going into resident’s bedrooms but listening outside. An individual risk assessment for each resident must be in place that states how often staff are to check them during the night so as not to disturb them unnecessarily. Ulysses House DS0000016734.V311792.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 The quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Arrangements are not sufficient to ensure that the people living in the home experience a meaningful lifestyle. Residents are offered a healthy diet but are not offered a choice of main meal. EVIDENCE: Resident’s records sampled showed and residents said that they go to college, go shopping, go to restaurants, cafes, zoos and to parks. Resident’s records showed that they liked doing these activities and residents said that they can choose what places they go to as long as staff are available to support them. One resident attends a work placement four days a week. Records showed where residents had been offered opportunities to go out but had refused this. In the records sampled it was recorded six times that residents did not go out to do the activities they had planned because of shortage of staff. Staff said that sometimes there is not enough money available for residents to be supported to do all the activities they want to do. The Acting Manager said that £270 per week is provided for resident’s food and activities and this is sufficient. He said that there needs to be more activities planned inside the Ulysses House DS0000016734.V311792.R01.S.doc Version 5.2 Page 13 home so residents can spend more time there. The completing of person centred plans with individuals will enable residents to say what they want to do and where they want to spend their time. In the dining room there is a pool table, a table football game, some paints and jigsaws. Staff said that residents do not use these very often. One resident had planned to go into town with a member of staff in the afternoon. Another resident did not want to go to college with the agency staff but with the Deputy Manager. This meant that the staff supporting the resident to go shopping had to cut their activity short so they could support the agency staff that did not know the residents at home so well. The resident who wanted to go into town said that they were very disappointed that they could not do what they had planned to do. As stated under the previous standards residents had not been on holiday yet this year and it was unclear how they had chosen the holiday that is currently being planned for them. Residents said that their relatives visit them and they are supported to visit their relatives. One resident had recently been in hospital. Records showed that their family were kept informed of their health needs and visited them regularly at the hospital. Other residents said that they were supported to visit the resident in hospital. Residents were observed making their own breakfast. Staff and residents said that residents are encouraged to do household chores and increase their independence skills. This was observed throughout the day. Residents had a key to their bedroom so they can lock it and keep it private if they want to. One residents records sampled showed that their TV was taken out of their bedroom at night and given back to them the following morning. It was not clear why this was done. The Acting Manager said that this had been agreed with the resident, their social worker and relatives. It was done to ensure that they established a good sleeping pattern and did not stay up all night watching TV and then find it difficult to do any meaningful activities during the day. A written agreement must be in place that states the reasons for this with clear guidelines on when the TV should be removed and when it should be returned to the individual. This should be signed by the resident or their representative and be subject to review. A resident was observed opening the door to the postman and sorting through the post to give to the relevant people. Residents were observed making their own drinks throughout the day so increasing their independence skills. The Acting Manager said that the menus had recently been updated and staff had asked residents what they wanted to eat. Menus reflected the cultural background of the residents. A choice was not offered on the menu. The Acting Ulysses House DS0000016734.V311792.R01.S.doc Version 5.2 Page 14 Manager said that he planned to rectify this. The Acting Manager has produced a recipe book to go with the menus so that staff who are not able to cook what the residents want are guided to do so. Residents said that they liked the food. Food records and menus sampled showed that a healthy and varied diet is offered that includes fresh fruit and vegetables. Fresh fruit and vegetables were available. Adequate food stocks were available in the home. Ulysses House DS0000016734.V311792.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 The quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents generally receive personal support in the way they prefer and require. Sufficient arrangements are not in place to ensure that the health needs of residents are always met. The arrangements for the management of the medication do not protect residents. EVIDENCE: Residents were dressed appropriately to their age, gender, cultural background, the weather and the activities they were doing. Residents said that staff support them to go shopping for their clothes. Staff were observed prompting and supporting residents to maintain their personal care and ensure that this was attended to. Staff were observed spending time with residents when they were upset or distressed and helping them to relax and calm down. One resident asked at the beginning of the day if staff could support them to go to the barbers to get their haircut. By the end of the day this had not been possible due to the amount of staff available to support all the residents in what they wanted to do. Health Action Plans were in place but had not been completed. This is a personal plan about what an individual needs to stay healthy and what Ulysses House DS0000016734.V311792.R01.S.doc Version 5.2 Page 16 healthcare services they need to access. Staff said that the Acting Manager had asked them to complete these with individuals but they were not sure how to do this. Residents records sampled showed that health professionals are involved in individuals care. These include the Psychiatrist and Psychologist. Residents records sampled showed that they had regular check ups with the optician and dentist. Residents are weighed monthly and a record of this is kept. One resident had recently been in hospital following an accident where they had to have surgery on their broken leg. The discharge letter from the hospital stated that the resident needed a post-operative appointment to have their stitches removed about the 4th October. The Acting Manager said that they are waiting for a phone call from the hospital telling them when this appointment would be. Given that this visit was on 10th October the Acting Manager was asked to chase this appointment to ensure that the resident receives the appropriate post-operative care. The resident is limited to activities in the home, as they do not have a wheelchair to access the community. Staff said that they are trying to get a wheelchair suitable for them so that they can go out. Since the inspection the Acting Manager said that the resident had visited the hospital to have their stitches removed and they now have a wheelchair to access the community. Lloyds Pharmacy supplies the medication to the home using the monitored dosage system in blister packs. The blister packs sampled at 3.40 pm showed that the 2pm medication had not been given to two residents. The Acting Manager told a member of staff who had just returned from being out with another resident to give it. The Medication Administration Record (MAR) for one resident had not been signed for their medication the evening before. The blister pack was empty indicating that the medication had been given but staff had forgotten to sign this. One resident’s MAR had been signed for 20:00 that evening but the medication was not out of the blister pack indicating that the member of staff had signed the MAR inappropriately. Medication was stored securely in a locked cabinet. Staff training records showed that staff had received training in the administration of medication. However, this training was not accredited and given the errors made it is evident that staff would benefit from further training in this. Ulysses House DS0000016734.V311792.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 The quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Arrangements are not sufficient to ensure that the views of individual residents are always listened to and acted on. Sufficient arrangements are not in place to ensure that residents are always protected from abuse, neglect and self-harm. EVIDENCE: The complaints procedure included all the relevant information so that residents or their representatives know how to make a complaint. Each resident had a copy of this. Residents said that they know how to make a complaint if they need to. There had been no complaints made to the home in the last 12 months. The CSCI had recently received two complaints about the home. One of these alleged that several staff had left and that adequate food stocks were not available. This was partially upheld as several staff have left and this impacts on the quality of life of the residents. Adequate food stocks were provided at the time of the inspection. The other complaint alleged that the Acting Manager had acted unprofessionally when the previous Manager came to visit residents. It is clear that the Acting Manager asked the previous Manager to leave the home and described the home as his requesting that all visitors should ask his permission to visit. The Acting Manager said that anyone is welcome to visit but they should ring to make sure the residents are here and to show that they value the individuals. This is a matter for the organisation to address with the Acting Manager to ensure that the home is run in a way that seeks the views and wishes of the people who live there. Ulysses House DS0000016734.V311792.R01.S.doc Version 5.2 Page 18 Two residents financial records were sampled. These showed that residents spend their money on personal items. Receipts are kept of all purchases. Resident’s money is kept securely in the home. The money in individual records cross-referenced with the amount on their financial records. Residents have their own bank accounts and they said that staff support them to go to the bank to get their money. The home uses the Crisis Prevention Institute (CPI) method of physical intervention to manage the resident’s behaviour. This is a proactive way of managing the individual’s behaviour to reduce the amount of times that a resident needs physical intervention from staff. Some staff have received training in CPI. Some staff have recently had training in the Breakaway method of physical intervention. This is a reactive method and staff learn how to keep themselves and the resident safe if a resident becomes distressed or aggressive. One residents records sampled stated that if they become physically aggressive staff are to diffuse this behaviour using CPI techniques. If staff have not received training in CPI they will not be able to do this effectively. An incident was reported to the CSCI in June 2006 where a resident was limping and had bruises on their elbow believed to be as a result of self-injurious behaviour. The action that staff said they needed to take to prevent this happening again was to be more proactive using CPI interventions whilst supporting the individual. Staff that have not received CPI training cannot support the resident appropriately. Staff had training in adult protection and the prevention of abuse in November 2005. Some bank staff working there had also received this training. Ulysses House DS0000016734.V311792.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28, 30 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Sufficient arrangements are not in place to ensure that residents always live in a comfortable, homely, safe, well maintained and clean environment. EVIDENCE: In the dining room there was a chair that was broken and the Acting Manager repaired this during the day. In the ground floor WC there was an offensive odour of urine and the toilet seat was loose. There was not a blind at the window so the WC was not private as it could be seen from the house next door. Hand wash and towels were provided in the toilets and bathrooms to prevent the risk of cross infection. The wallpaper on the ceiling in one of the residents bedroom and en suite was peeling and it seems that there may be a problem with the roof leaking. The Acting Manager said that this would be looked at when the residents go on holiday. The bedroom required redecoration and the lampshade was broken. The ceiling paper in the other resident’s bedroom on the second floor was also peeling and their lampshade was broken. Ulysses House DS0000016734.V311792.R01.S.doc Version 5.2 Page 20 Some areas of the home had recently been redecorated making it look clean and more comfortable for the residents to live in. The Acting Manager said that the bathroom on the first floor is to be refurbished when the residents are on holiday and the bath will be replaced. The bathroom was clean. The WC on the first floor was clean, it had recently been repainted and the toilet seat had been replaced. The radiator cover in the lounge had been damaged and is in need of replacing. The lounge is well decorated and a comfortable room for residents to spend time in. The Acting Manager said that the kitchen is to be repainted. All kitchen cupboards were in a good state of repair. Staff said that the dishwasher was working. The doorframes to the laundry room had been repainted. The washing machine and tumble dryer were working so that resident’s clothes could be washed when needed. The gate leading from the garden to the exit at the side of the house cannot be opened so there is not an exit from the garden to the outside except through the house. This could be a danger if there is a fire. The Acting Manager said that this gate is to be replaced so it can be an alternative fire exit. The fence had been repaired since the last inspection so the garden is private for residents to spend time in. There is a large grassed area in the garden and a shed that residents can smoke in. The Acting Manager said that it is hoped that an activity room can be built in the garden to provide another space for residents and to make better use of the space that is there. The Acting Manager said that there is going to be a sofa and a TV provided for the dining room to provide another room for residents to sit in. Sometimes it is difficult for other residents to relax if one of the residents is displaying behaviour that challenges. The home was generally clean and free from offensive odours. Ulysses House DS0000016734.V311792.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 The quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The arrangements for staffing the home, their support and development do not ensure that the individual needs of residents can be met. EVIDENCE: Two members of staff have NVQ level 2 in Health and Social Care. Three members of staff are currently doing this training. This does not meet the standard that at least 50 of the staff have NVQ level 2 or ensure that staff have the skills individually and collectively to meet residents needs. The Acting Manager, the Deputy Manager, a permanent member of staff, a bank staff and an agency staff were on duty. The bank staff had worked some shifts in the home for the last three to four months. The agency member of staff had worked in the home previously and knew the residents. Three members of staff have left since the last key inspection so there are less staff who know the residents well. Some residents records sampled stated that residents could not go out because of shortage of staff. Staff meeting minutes showed that these are held monthly. The Acting Manager said that it because of the times of staff meetings it is difficult to get night staff to attend. He was advised to alternate the times of meetings if possible but he said that several of the day staff would not be able to attend Ulysses House DS0000016734.V311792.R01.S.doc Version 5.2 Page 22 later in the evening. The night staff and any staff who cannot attend should have a copy of the minutes and sign to say they have read them to ensure they have received the necessary information. Four staff recruitment records were sampled. These included the required recruitment records including evidence that a satisfactory Criminal Records Bureau (CRB) check had been undertaken to ensure that suitable people are working with the residents. There is a maintenance person that regularly works in the home. There were no records regarding how they were recruited and a satisfactory CRB check had not been undertaken. The consultant said that the maintenance person is self-employed and not an employee of the company. However, it is still important to ensure that they are a suitable person to have regular contact with the residents so a CRB check must be undertaken. Training records showed that eight staff have received training in medicine awareness, five staff have received first aid training and the Acting Manager had received training in Managing Challenging Behaviour. Staff records sampled showed that staff had received training in adult protection and the prevention of abuse, health and safety, fire safety, Crisis Prevention Institute (CPI) method of physical intervention and Breakaway method of physical intervention. All staff require this training to enable them to meet residents individual needs. Staff have not received training in meeting the individual needs of residents. One residents care plan stated that they use MAKATON sign language to communicate. Staff have not received training in this. Staff supervision records sampled showed that staff have not had at least six recorded, formal supervision sessions with their manager in the last year. They need to have these to ensure that they are supported in their job role, know how to meet the needs of the residents and any training and development needs are identified. Ulysses House DS0000016734.V311792.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The arrangements for the management are not sufficient to ensure that residents benefit from a well run home. Residents cannot always be confident that their views underpin all selfmonitoring, review and development by the home. The arrangements are not sufficient to ensure that the health, safety and welfare of residents is always promoted and protected. EVIDENCE: An Acting Manager is in post. They have not yet applied to the CSCI to be registered. They have experience of working with people with a learning disability and in a supervisory capacity. The Acting Manager has limited experience of managing a home and the consultant said they are working with him to support him in this area. Some staff raised concerns about the management style of the Acting Manager. Since this inspection the consultant has met with staff to discuss this further and is supporting the Acting Manager Ulysses House DS0000016734.V311792.R01.S.doc Version 5.2 Page 24 to ensure improvements are made for the benefit of residents. The Acting Manager has NVQ level 4. A consultant employed by the owner visits the home every month to complete an audit and a report of these visits is forwarded to the CSCI. Residents completed a survey in August 2006 asking for their views on food, activities, choices they can make, holidays, the house and their bedroom, the staff and the other residents. One resident said that they were happy with the choice of food, they get enough help to be able to make choices, staff support them to go shopping for their clothes, staff support them to do their laundry, cleaning and go shopping for food, they are happy with the house, staff and the other residents. They said that they would like to go on holiday and would like to get out more. There was not a record of the action taken to ensure that action is taken and their views are listened to. Fire records showed that staff test the fire alarm and emergency lighting regularly to make sure they are working. A fire drill had not been held since January 2006. The Acting Manager said that there was a fire drill about three weeks before but this had not been recorded. A copy of a record of a fire drill held the day after the inspection was forwarded to the CSCI. There must be a fire drill at least every six months so that staff and residents know what to do if there is a fire. The fire risk assessment was dated November 2005 and detailed what action was needed to minimise the risk of a fire starting. An engineer had serviced the fire extinguishers in September 2006 to make sure they are in good condition and will work if needed. Staff test the fridge and freezer temperatures daily. These were recorded as within the limits for safe food storage to prevent the risk of food poisoning. Staff test the water temperatures weekly to make sure they are not too hot or cold. These tested between 39 – 42 degrees centigrade. The recommended safe temperature is 43 degrees centigrade. A Corgi registered engineer completed the annual check of the gas equipment in December 2005 and stated that it was in a satisfactory condition. An electrician had completed the five yearly electrical wiring installation test in 2001 and this was due again. This was completed on 14th October and the electrician said that the installation was in a good condition. The electrician also completed the annual test of portable electrical appliances to make sure they are safe to use. A valid certificate of employers liability insurance was displayed in the home. Ulysses House DS0000016734.V311792.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 x 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 x 26 2 27 2 28 2 29 x 30 2 STAFFING Standard No Score 31 x 32 2 33 2 34 2 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 2 2 x LIFESTYLES Standard No Score 11 x 12 1 13 2 14 2 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 1 x 2 x 2 x x 2 x Ulysses House DS0000016734.V311792.R01.S.doc Version 5.2 Page 26 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 5 (1) (a), 6 (a) 15(1) 12 (2) (3) Requirement The service users guide must be updated to reflect the changes in staffing and management. Person centred plans must be completed for all residents. The views of residents and their wishes must be taken into account. Staff must be available to ensure that residents receive the care and support that they need. An individual risk assessment for each resident must be in place that states how often staff are to check them during the night so as not to disturb them unnecessarily. Sufficient staff must be available to ensure that residents can take part in varied and fulfilling activities. A written agreement must be in place that states when the TV must be removed from one residents bedroom at night and when it should be returned. This must be signed by the resident or their representative DS0000016734.V311792.R01.S.doc Timescale for action 31/12/06 2. 3. YA6 YA7 YA8 31/12/06 31/10/06 4. YA9 13 (4) (a-c) 30/11/06 5. YA12 YA33 YA13 YA16 18 (1) (a, b) 30/11/06 6. 12 (2) (3) 12/11/06 Ulysses House Version 5.2 Page 27 and be subject to review. 7. YA19 Each service user must have a Health Action Plan in line with the Government White Paper ‘Valuing People.’ Outstanding from previous inspections. 13 (2) Medication must be given to residents as prescribed. 13 (2) 18 Staff that give medication to (1) (a, c) residents must receive accredited training in the ‘Safe Handling of Medicines.’ 13 (7), 18 All staff must receive training (1) (a, c) in CPI. 16 (2) (k), The ground floor WC must be 23 (2) (c, d) thoroughly cleaned and the toilet seat replaced. A blind must be provided at the window. 23 (2) (b, c) The radiator cover in the lounge must be replaced. 23 (4) (b) The gate leading from the garden to the front exit must be replaced with a gate that can be opened in the event of an emergency. 23 (2) (b, d) The second floor bedrooms must be redecorated and the lampshades replaced. 18 (1) (a-c) At least 50 of care staff must have NVQ level 2 or above in Health and Social Care. 19 (1), Sch A satisfactory Criminal Records 2 Bureau check must be undertaken for the maintenance person who regularly works at the home. 18 (1) (a, c) Staff must receive training in meeting the needs of individual residents. 18 (2) All staff must receive regular formal, recorded supervision sessions with their line manager. Outstanding from previous inspections. DS0000016734.V311792.R01.S.doc 12 (1) (a, b) 31/10/06 8. 9. YA20 YA20 10/10/06 31/01/07 10. 11. YA23 YA35 YA24 YA27 YA30 31/12/06 31/12/06 12. 13. YA24 YA24 YA42 30/11/06 30/11/06 14. 15. 16. YA26 YA32 YA34 30/11/06 31/01/07 30/11/06 17. 18. YA35 YA36 31/01/07 30/11/06 Ulysses House Version 5.2 Page 28 19. 20. YA37 YA42 8 23 (4) (a, e) An application for the manager to be registered must be made to the CSCI. There must be a fire drill at least every six months and a record of this must be kept. 30/11/06 11/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. 8. Refer to Standard YA1 YA9 YA14 YA17 YA22 YA8 YA28 YA33 YA39 Good Practice Recommendations The service users guide should be produced in an accessible format for the residents. All staff should read individual residents risk assessments and sign to say they have done so. Each resident should be given the opportunity to go on holiday each year. The menu should include an alternative to the main meal. The home should be run in a way that considers the views of individual residents. It is recommended that the garden be further developed to increase the use of it by residents. The night staff and any staff that cannot attend staff meetings should be given a copy of the minutes and asked to sign to say they have read them. A plan of what action is to be taken to ensure that resident’s views are listened to should be in place. Ulysses House DS0000016734.V311792.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ulysses House DS0000016734.V311792.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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